15039 (ELEC)4
P.O. BOX 1504 No. 15039 .
Building 78-495 CALLE TAMPICO
Address 78-783 LiMa LA QUINTA, CALIFORNIA 92253
Owner
Colony Cablevision
Mailing p.Q. BOX 368
Address
CityZip
Tel.
Palm. Desert, 3M26i
340-1312
Contractor
Cochran Gfal".�4t3riica'I idja Const.
Address
36630 Cathedral Canyon Dr.
City -
Cathedral Citd,
Zip
CA
Tel.:
328-6778
State LiaC7 478543
& Classif.
City 856
Lic. #
Arch., Engr., ,
Designer
Address
Tel.
-
City ( Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby -affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7900) ofrDivision 3 of the.Business and Professions Code, and my license is i full force and,
SIGNATURE P, V E- DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busfness and Professions Code: Any city or county- which *requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also "
.requires the applicant for such permit to rile a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law. Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code; or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars (5,500). .
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or Improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or Improve for the purpose of sale.) . .
❑ I, as owner of the property, am exclusively contracting with licensed contractors to -con-
struct the project. (Sec. 7044, Business and -Professions Code: The Contractor's License Law
does not apply to an, owner of property who builds or Improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
11 1 em exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affitm that I have a certificate of consent to self -insure, or a certificate of
Worker'spKensa_tion Insurance, or a certified copy thereof: (Sec. 3800, Labor Code.)
Polii,cy%40. Company
17 Copy is filed with the city, O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE.
(This section need not be completed if the permit is for one hundred -dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I 'shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date--L-Own . er
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,'INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when property filled out, signed and validated, and is subject to
expiration If work thereunder is suspended for 160 days.
I certify that I, have read this application and state that :the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building*
construction, and hereby authorize representatives .of this city. to enter the above-.
mentioned property for Inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING:- TYPE CONST. OCC. GRP.
Number
Legal Description -
Project Description 10() aft+p pedestal
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Pr,Q� e
Side Street Setback fro rNf:%L
- Side Setback from Prope , Iqe
FINAL DATE
Issued by: Date_
Validated by:
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
- Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$700.00
.. I
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const'.
Mech.
Electrical
33.50
Plumbing
S.M.1:
Grading
Driveway Enc.
Infrastructure
TOTAL
33.50
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Pr,Q� e
Side Street Setback fro rNf:%L
- Side Setback from Prope , Iqe
FINAL DATE
Issued by: Date_
Validated by:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW%3 FEES
1ST FL. SO. FT. ® $
UNITS
ROUGH PLUMB. BONDING
2ND FL. SO. FT.
STORAGE TANK
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
REINF. STEEL
DRAINAGE PIPING
WALL SD. FT.
DRINKING FOUNTAIN.
SO. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER' SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
LUMBER GR.
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC -
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
• LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR p 3/ac
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL'.CK.FEE
CONST. FEE IELECT,FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING I ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING,(ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC -TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE'
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL).
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATERHEATER SERVICE
FINAL INSP.
BOND BEAM
WATER' SYSTEM
RADING
— cu. yd.
$ plus x$
_
=$
LUMBER GR.
FINAL INSP/—/---
zi
FRAMING
FINAL INSP.
ROOFING
D�
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
-FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL